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N232 > Module 3: Pain Management > Flashcards

Module 3: Pain Management Flashcards

1
Q

what routes can opioids be administered?

A

orally, IV, subQ, intraspinal, rectal, and transdermal

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2
Q

what are the adverse effects of opioids?

A

respiratory depression and sedation, nausea and vomiting, and constipation

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3
Q

what patients are more susceptible to the adverse effects of opioids?

A

patients with undertreated hypothyroidism; may require a larger dose

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4
Q

what patients are more susceptible to the respiratory effects of opioids?

A

patients with dec. respiratory reserve from disease or aging

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5
Q

what does the nurse assess upon the first administration of opioids?

A

BP, heart rate, resps, and pain

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6
Q

what does the nurse do if the pain is not relieved on opioid treatment?

A

assess vitals again and if patient is alert, may need to inc. dose (need a physician to determine this)

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7
Q

what is tolerance in opioid therapy?

A

tolerance develops in patients that have been using opioids to for an extended period of time

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8
Q

what do patients that have a high tolerance to opioids need in order to achieve the therapeutic effects?

A

an increased dose

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9
Q

what are local anesthetics?

A

they block nerve conduction when applied directly to nerve fibers

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10
Q

how can local anesthetics be applied?

A

directly to site or infused around nerve fiber or epidural catheter

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11
Q

what are local anesthetics good for?

A

pain associated with thoracic or upper abdominal surgery when injected by surgens into the intercostal space

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12
Q

when is the spinal administration of local anesthetics used?

A

during surgery or labour and delivery

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13
Q

what else can anti-seizure meds be used for?

A

neuro pain

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14
Q

when is balanced analgesia most effective?

A

when multimodal (use of more than one to obtain more pain relief with few SE)

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15
Q

what is patient-controlled analgesia?

A

used for post-operative pain

- allows pt to self-administer in a safe range

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16
Q

what route of analgesics are preferred in acute care settings?

A

IV (rapid effect)

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17
Q

what is the period of time analgesics are pushed through the IV in acute care?

A

10-15 min period

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18
Q

which patients is subQ good for when giving analgesics?

A

CA pts

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19
Q

what is the preventative approach?

A

when the therapeutic levels are maintained

  • on timed basis instead of waiting for the patient to report pain
  • smaller doses are needed
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20
Q

why is the preventative approach good?

A

reduces the amount of time the pt is in pain

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21
Q

can severe pain be relieved by oral meds?

A

yes, if the dose is high enough

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22
Q

when is the rectal route preferred?

A

for patients with bleeding problems

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23
Q

what are transdermal patches used for in terms of opioids?

A

used to achieve a consistent opioid serum level through absorption of the medication via the skin

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24
Q

what should never be placed on a transdermal patch?

A

a heating pad

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25
Q

where do intraspinal medications get administered?

A

into sub-arachnoid space or epidural space

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26
Q

what is a side effect of intraspinal or epidural meds?

A

spinal headache (more likely in pts less than 40 years of age)

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27
Q

when can respiratory depression occur in intraspinal or epidural administrations?

A

6-12 hours after administration

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28
Q

what is the definition of analgesics?

A

drugs that relieve pain without causing loss of consciousness

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29
Q

what is the definition of opioids?

A

any drug that’s natural or synthetic that has actions similar to those of morphine

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30
Q

what are the three main opioid receptors?

A

Mu, Kappa, Delta

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31
Q

what activates Mu receptors?

A

analgesia, respiratory depression, euphoria, and sedation

- also by physical dependance

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32
Q

why are Mu receptors necessary?

A

to mediate major actions of opioid drugs

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33
Q

what can Kappa receptors produce upon activation?

A

same as Mu - analgesia and sedation

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34
Q

what is morphine the prototype of?

A

strong agonists

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35
Q

what is codeine a prototype of?

A

moderate to strong agonists

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36
Q

what is naloxone a prototype of?

A

purse opioid antagonists

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37
Q

what are the effects of morphine?

A

relieves pain, causes drowsiness/mental clouding, reduces anxiety and creates a sense of well-being

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38
Q

what happens with prolonged use of morphine?

A

produces a tolerance and physical dependence

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39
Q

what kind of pain is morphine most effective with?

A

dull, constant pain

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40
Q

what kind of pain is morphine not as effective with?

A

intermittent & sharp pain

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41
Q

what is CRUCIAL to monitor with patients on opioid meds?

A

level of consciousness, resp. rate, and oxygen saturations

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42
Q

how do opioids promote constipation?

A

promoting Mu receptors in the gut

  • suppress propulsive intestinal contractions
  • intensify non-propulsive contractions
  • increase the tone of the anal sphincter
  • inhibit secretions of fluid into intestinal lumen
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43
Q

how can constipation d/t opioids be managed?

A

inc. physical activity, inc. intake of fibre and fluids, enema

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44
Q

how can morphine affect the urinary system?

A

can cause inc. UR and urinary hesitancy

- inc. tone of bladder sphincter and inc. tone of detrusor muscle

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45
Q

what should you encourage a pt on morphine to do d/t what it does to bladder?

A

urinate every 4 hours to improve discomfort

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46
Q

how does morphine decrease urine production?

A

decreases renal blood flow and partly by promoting release of antidiuretic hormone

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47
Q

how does morphine effect coughs?

A

it suppresses coughs

48
Q

what do opioids do to the bile ducts?

A

induce spasm, causing . problems within the biliary tract to rise dramatically

49
Q

how do opioids effect emesis?

A
  • promotes nausea and vomiting

- reduced in pts remaining still

50
Q

what can opioids do to intracranial pressure (ICP)?

A

increase pressure

51
Q

what is euphoria?

A

exaggerated sense of well-being

52
Q

what causes euphoria?

A

Mu receptors

53
Q

what is dysphoria?

A

a sense of anxiety and unease

54
Q

when is dysphoria common?

A

when morphine is taken in the absence of pain

55
Q

when is dysphoria uncommon?

A

when the patient is in pain

56
Q

how can sedation while taking opioids be avoided? (3)

A
  • taking smaller doses more often
  • using opioids that have short half lives
  • giving small doses of a CNS morning and early afternoon
57
Q

when can neurotoxicity take place with the use of opioids?

A

renal impairment, pre-existing cognitive impairmant, prolonged high-dose use

58
Q

what can neurotoxicity cause?

A

delirium, agitation, myoclonus, hyperalgesia

59
Q

how can you manage neurotoxicity?

A

hydration and dose reduction

60
Q

what are adverse effects of using opioids long-term?

A
  • hormonal changes

- alter immune system

61
Q

what are some pharmacokentics about opioids?

A
  • poor lipid solubility
  • doesn’t cross the BBB easily
  • oral doses need to be much larger than parenteral doses to achieve same effects
62
Q

how long does morphine withdrawal syndrome last?

A

7-10 days

63
Q

what are the 4 routes of fentanyl?

A

parenteral, transdermal, transmucosal, intranasal

64
Q

what can fentanyl be used for?

A

surgical analgesia, chronic pain control, and control of break through pain

65
Q

where should a fentanyl patch be applied?

A

upper torso

66
Q

how long does a fentanyl patch take to reach effective levels?

A

24 hours

67
Q

how long do drug levels stay steady in a fentanyl patch?

A

48 hours - should be replaced now

68
Q

in which patients is fentanyl persistent in for severe pain?

A

patients over 18 and over 110 pounds

69
Q

what happens if you apply heat to a fentanyl patch?

A

could accelerate fentanyl release

70
Q

how should nurses dispose of fentanyl patches?

A

folded in half and into the sharps bin

71
Q

what are the 4 formulations of the transmucosal route?

A
  1. lozenges on a stick
  2. buccal tablets
  3. sublingual tablets
  4. sublingual spray
72
Q

when is the transmucosal route used for fentanyl?

A

in CA patients ONLY

73
Q

what is methadone used for?

A

to relieve pain and treat opioid addiction

74
Q

what is methadone similar to?

A

morphine

75
Q

what route is methadone effective and how long?

A

orally; long duration of action

76
Q

what is hydromorphone similar to?

A

morphine

77
Q

what is the indication of hydromorphone?

A

moderate to severe pain

78
Q

what SE can hydromorphone have?

A

same adverse effects as fentanyl, may cause less nausea than morphine

79
Q

what are moderate to strong opioid agonists important?

A

produce less analgesia and resp. depression than morphine and have lower potential for abuse

80
Q

what is the indication of codeine?

A

relief of mild to moderate pain

81
Q

what route is common for codeine?

A

PO

82
Q

what happens to codeine in the liver?

A

about 10% converts into morphine (active form of codeine)

83
Q

what drug can you combine codeine with? why?

A

aspirin/acetaminophen

- combining increases pain relief

84
Q

what effect does codeine have on coughs?

A

extremely effective cough suppressant

85
Q

what other drug has the similar properties as methadone?

A

morphine

86
Q

what is naloxone?

A

opioid agonist

87
Q

what is the indication of naloxone?

A

blocks effects of opioid agonists

88
Q

what is the action of naloxone?

A

structural analog of morphine that acts as a competitive antagonist at opioid receptors, therefore blocks opioid actions

89
Q

how can naloxone be administered?

A

IV, IM, subQ

90
Q

what are gabapentin and amitriptyline used for?

A

to complement the effects of opioids, used in combination

91
Q

what effects can adjunctive analgesics have? (3)

A
  1. enhance analgesia from opioids
  2. help manage concurrent symptoms that exacerbate pain
  3. treat SE caused be opioids
92
Q

what are two examples of adjunctive analgesics?

A

gabapentin and amitriptyline

93
Q

what type of pain are adjunctive analgesics useful for?

A

neurologic pain

94
Q

what were adjunctive analgesics originally meant to treat?

A

depression, seizures

95
Q

what are common antidepressants?

A

tricyclic antidepressants (TCA)

96
Q

what kind of antidepressant can treat neuropathic pain?

A

amitriptyline

97
Q

what are adverse effects of TCAs?

A

orthostatic hypotension, sedation, anticholinergic effect

98
Q

what can antiseizure drugs also be used for?

A

relieve neuropathic pain

99
Q

where is the greatest concentration of marijuana?

A

in the flowering tops of female plants

100
Q

where is the lowest concentration of marijuana?

A

in the seeds

101
Q

what is hashish?

A

dried preparation of the resinous exudate from female flowers

102
Q

how long does it take for subjective effects of marijuana to take place?

A

minutes

103
Q

when is the peak for marijuana?

A

10-20 mins

104
Q

how long can effects of marijuana last?

A

2-3 hours

105
Q

how much of marijuana reaches the systemic circulation when it is ingested?

A

only 6-20%

106
Q

how much larger do oral doses have to be compared to smoked doses for marijuana?

A

3-10x greater to produce equivalent effects

107
Q

how long is the delayed effect of oral marijuana dosing?

A

30-50 mins

108
Q

what 3 subjective effects does marijuana produce?

A
  1. euphoria
  2. sedation
  3. hallucinations
109
Q

what is amotivational syndrome?

A

associated with excessive marijuana use - includes apathy, dullness, grooming, reduced interest in achievement, and disinterest in the pursuit of conventional goals

110
Q

what mental health problem can marijuana increase the risk of?

A

schizophrenia

111
Q

how does marijuana effect HR?

A

“rose-related” increase in heart rate

112
Q

what effect can marijuana have on males?

A

dec. spermatogenesis and testosterone

113
Q

what effect can marijuana have on females?

A

dec. levels of FSH and LH and prolactin

114
Q

what are symptoms of marijuana dependence?

A

irritability, restlessness, nervousness, insomnia, reduced appetite, and weight loss

115
Q

when do withdrawal symptoms subside with marijuana?

A

3-5 days (moderate users do not experience these)

116
Q

how can marijuana help with glaucoma?

A

smoking can reduce intraocular pressure but may also reduce blood flow to optic nerve

117
Q

what are some therapeutic uses for marijuana?

A

reduces chronic pain

  • suppresses nausea caused by chemo
  • improves appetite in patients
  • suppresses spasticity with MS and spinal cord injury

N232 (9 decks)

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